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LECTURES ON HOME NURSING 
FOR THE POOR 



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■ 

I 



F 58a CCy 



LECTURES 

ON 

HOME NURSING 

FOE THE POOE 






BY 

A DISTRICT NURSE 



THE SCIENTIFIC PEESS, LIMITED 

28 and 29 SOUTHAMPTON STEEET, STEAND, 
LONDON. W.C. 



THE NURSE'S OWN PAPER. 

THE 

NURSING MIRROR. 

Being a Separate Issue of the 
Nursing Section of "The Hospital". 

ONE PENNY WEEKLY. 

Jhe I$est jtiedium for 
Jfppointnjents Vacant and Wanted. 



TERMS OF SUBSCRIPTION. 

Great Britain Foreign & Colonial 
(post free). (post free). 

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For One Year 6 6 8 8 

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and are payable in advance. 



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Publishing Offices : THE HOSPITAL BUILDING, 
28 & 29 Southampton Street, Strand, London, W.C. 



SISTEE CATHEEINE M- 



INTRODUCTION. 

Twice I have given these lectures in my district, 
mainly to working girls. At the examination held 
afterwards the answers to questions drawn at ran- 
dom were generally correct and detailed. I have 
also found good results from them in my district. 

They are based on my experience of sickness 
amongst the poor, and a knowledge of what can be 
done under their conditions ; and what cannot be 
done. Those limits make the difference between 
private and district nursing. But an immense 
amount of unnecessary suffering would be prevented, 
many complications, too, and many lives saved, if 
the simple teaching of these lectures were under- 
stood generally by the poor. 

Plain everyday terms, illustration, minute ex- 
planation on any detail that could be misunderstood, 
repetition — all this is essential. Everything that 
can be done before the people I do ; and I never 
use a technical term. Before the second lecture I 
give half the time to questions on the first ; and so 
on each succeeding lecture I begin by questions on 
the last. After the last lecture I give an evening to 
going through all the questions. 

(vii) 



Vlll INTRODUCTION. 

It is necessary to charge a penny at the door to 
keep uninterested people out. I have also restricted 
attendance to women and girls over fifteen. In a rough 
district it is best to have a man at the outer door. 

Prizes after an examination are a great incentive 
to attendance. It is well to have strangers to 
examine, two nurses, or a nurse and a lady to 
help her. Before the " question " evening, the 
questions and answers must be so arranged (com- 
bined or sub-divided) as to have a question from 
each lecture for each competitor. 

To prevent confusion at the examination, or sus- 
picion and discontent afterwards, I have found the 
following plan answer. (It is impossible to avoid 
a good deal of previous work if an examination is to 
go smoothly.) 

(1) Write out the questions and answers as you 
have asked and taught during the lectures. Say 
there are 20 competitors. Divide your list at 20, 
40, 60, 80, 100, 120 by (1), (2), (3), (4), (5), (6). So 
that you have before you every question and answer 
with its number. 

(2) Have 20 folded slips of paper, numbered from 
1 to 20. 

(3) Have 120 folded slips of paper, numbered from 
1 to 120. Divide into six groups — 1-20, 21-40, and 
so on. 

(4) Fold a margin on a sheet of lined foolscap, 
Under the number of each lecture write numbers 
from 1-20 in the margin, and on the line correspond- 
ing to it a, b, c. Like this — 



INTRODUCTION. ix 

Lecture (1). 

1. (a) (b) (c) 

2. (a) (b) (o) 

and so on. (a) means fully answered, (b) partially 
answered, (c) not answered. 

The examiners sit at a table facing the competi- 
tors. One has the numbered list of questions and 
answers ; the other the paper for marks. The slips 
of paper are in seven heaps — one in front ; the 
others in a row according to the order of the lecture 
each represents. Like this — 

(1) (2) (3) (4) (5) (6). 

(1). 

First, each competitor draws a number from the 
front heap, and takes it back to her seat. That is 
her number for the evening. 

An examiner calls " Number I." The competitor 
who has drawn (1) goes to the table, picks out a 
slip from heap (1), and hands it to the examiner, who 
asks her the question belonging to that number on 
the paper. After she has answered, an X is put 
against the (a), (6), or (c) on the line of her number 
in "Lecture (1)". When the 20 questions are 
asked, the next heap is begun. And so all through. 
It is well to let the competitors know the method 
that is followed, and which letter is marked each 
time. If "a" means 2 marks, "b" 1, and "c" 
none, the counting and decision are simple. 

I have made a point of keeping at the further end 

b 



X INTRODUCTION. 

of the room. As the examiners are strangers, I 
generally hold a duplicate of question and answer 
paper, in order to help in any mistake or possible 
blunder. The prize giving should be made as 
festive and public as possible. 

I hope these hints may spare my readers all the 
time and trouble it cost me to think out these 
details. 

My lectures are the outcome of my own observa- 
tion of what teaching on nursing the poor need 
most. During nearly twelve years I have done 
district nursing in a mining and manufacturing 
town in the north, and in a large provincial town. 
I have also nursed the poor in Paris and in London. 

Even amongst the educated and well-informed, 
when I did private nursing abroad, I found an 
extraordinary ignorance of the simple teaching con- 
veyed in these lectures. In adapting these lectures 
for that class I should use briefer and technical 
language, and advise luxuries instead of makeshifts. 
For use in schools scarcely any alteration would be 
needed. 

The books that helped me in my nursing have 
also helped me in the preparing of my lectures. I 
have to thank specially, Laurence Humphrey, M.A., 
M.D. ; Percy G. Lewes, M.D., M.E.C.S., L.S.A., 
A.K.C. ; C. S. Weeks-Shaw ; Sam. Osborne, F.E.C.S. 

NUESE A. M. F. COLE. 

Norwich, January, 1906. 



CONTENTS. 



LECTURE I. 

PAGE 

General Care op the Sick Person and the Sick-Room . 1 



LECTURE II. 
The Doctor — Prevention and Treatment of Bed-Sores . 11 

LECTURE III. 
Poultices — Fomentations — Dressing op Wounds — 

Dangers op Quick Healing and Quacks ... 22 

LECTURE IV. 
Typhoid, What it is, and How to Nurse it . .32 

LECTURE V. 
Infants and Children .43 

LECTURE VI. 
Convalescence — Emergencies 54 



(xi) 



LECTUEE I. 

GENERAL CARE OF THE SICK PERSON AND THE SICK- 
ROOM. 

Things Eequired for Lecture I. 

1. A rough diagram 1 of the human form, with heart, 
main arteries and veins, and a rough idea of circulatory 
system. 

2. A rough diagram of sections of the heart, showing 
auricles and ventricles, and the beginning of veins and 
arteries. 

Note. — These may be done in red and blue pencil, or in red and 
blue ink. All that is arterial must be red. All that is venal, 
blue. 

3. A small bed made in the ordinary way. A girl in 
a loose nightgown over her clothes. Two extra blankets 
and sheets. Two towels. A mackintosh. A small piece 
of blanket, or a clean flannel garment. An extra night- 
gown. 

4. A basin, flannel and soap. 

5. A cup, spoon and feeding-cup. 

Note. — The pretended patient's clothing need never be removed, 
nor need any water be used, nor drink be given. Only show all the 
movements. 

In giving these lectures, the lecturer must have an assistant. 

1 1 give miniatures in this book of the rough diagrams I made in 
red, blue, and black pencil. They are sufficient for the subjects. 



LECTURE I. 

1 , The three things most necessary in a sick person's 
room are (1) fresh air ; (2) cleanliness ; (3) order. 

2, Fresh air is so necessary because nothing else can 
make good clean blood ; and health and life depend on 
the blood. 

3, The blood starts from the right side of the heart and 
goes all over the body, giving nourishment and taking up 
impurities. It comes back, poor and impure, to the left 
side of the heart. 1 

4, The blood goes from the left side of the heart into 
the lungs. The fresh air that we breathe into the lungs 
makes the blood clean and good again. The air we breathe 
out from the lungs carries out the impurities the blood 
has taken up during its journey through the body. From 
the lungs the blood goes back to the right side of the 
heart, and begins its journey all over the body again. 2 

5, Fresh air contains a gas called oxygen, which is 
necessary for life, and which the blood carries all over the 
body. Too little oxygen makes people ill. Without any 
they must die. 

6, People in a room with doors and windows shut, and 
no fresh air coming in, breathe in the dirty air that other 
people have breathed out. In the air we breathe out there 
is a poisonous gas called carbonic acid. In a "close" 
room we breathe in this poison instead of oxygen. In 
that way the blood becomes poor and impure. 

1 Show diagram 1. 2 Show diagram 2. 

(2) 



LECTUEB I. 




HOME NURSING OF THE POOR. 



7. A sick person should always be washed when he is 
ill, just as much as when he is well. Use hot water, and 
wash and cover up quickly. Always keep the feet clean. 
A sick person should be clean from the crown of his head 
to the soles of his feet. 



<^yi 



{clung 




8, To wash the feet in bed, 1 turn up the bed-clothes 
from the foot of the bed, lay something thick under the 
foot you wash first, and leave the other covered. Use hot 
water and soap and wash quickly ; dry, and cover up in 
a blanket or something as warm. Do the other foot the 
same. Have all you want ready before you begin. 

9. To wash a sick person all over in bed put a blanket 

1 Get basin, soap, towel, something to lay under the feet to be 
washed, and something to wrap them in after, ready first. Then 
show how. Keep stockings on. 



LECTURE I. 5 

under him and another over him. 1 If you have a 
mackintosh, put it under the blanket. If not take care 
not to wet the blanket so as to make the bed damp. 
Take off the nightgown, and if in winter hang it by the 
fire. Wash the face and ears and dry them. Take one 
arm and wash and dry and cover up. Then the other 
arm, and cover up. Then wash the chest and all the front 
part of the body, uncovering as little as possible. Then 
turn up the bed-clothes from the foot of the bed. Un- 
cover and wash one leg, and dry and cover again. Then 
take the other leg and do the same. Turn on one side 
and wash back, and all that has not yet been done. Wash 
most carefully and thoroughly those parts that need most 
washing. Draw the blankets away, and put on the night- 
gown. 

10, A sick person should have only what food the 
doctor orders, and as much as the doctor orders. If he 
cannot take what is ordered tell the doctor, and he will tell 
you what to do. Give a little at a time. 2 Don't leave any 
in the room. Always bring it on a clean plate, or in a 
clean cup or glass. Before giving food to a very sick person 
tuck a cloth under the chin to prevent soiling bed-clothes. 

1 1 , In the room of a sick person be quiet and cheerful. 
Don't allow any one to talk loudly or to whisper. Oil 
creaking doors and wedge rattling windows. Keep coal 
outside, and bring in, on a shovel, as you want it. For 
the night shade light from the face. Get ready lumps of 
coal wrapped in paper, so that you can put them on with 
your fingers. Take care that the feet are warm. 

1 Show how to do this. Go through every detail except actual 
washing. (' ' Patient " of course keeps her own clothes on.) Make a 
great point of having everything at hand before beginning. 

2 Feed with spoon and feeding-cup. 



6 HOME NURSING OF THE POOR. 

12. One window should always be open night and 
day — wide open in warm weather, and at least a few 
inches open in cold weather. If in cold weather the room 
needs thorough airing, cover the sick person entirely, 
even his face, with a thin blanket and open the window 
wide for a few minutes. Never cover the face of a dying 
person, or one who has a difficulty in breathing, or one 
ivho is unconscious. 

13. If the bed is in a draught between the door and 
window hang a curtain, or a sheet, on a line fastened 
to nails in the wall, so that it will screen the sick person 
either from the door or the window. 

14. The bed should be made every day. Ask the 
doctor if the sick person may get out of bed to have it 
made. 

15. A draw-sheet 1 is any sort of sheet folded length- 
ways, wide enough to reach from the waist to the knees of 
the person in bed, and laid across the bed, and tucked in 
on either side. Its uses are (1) to protect the bed from 
soil or wet when it is over a mackintosh ; or (2) for lift- 
ing or moving a helpless person. 

16. To make a large feather-bed with a sick person in 
it, move him as far to one side as possible, and after one 
side of the bed is thoroughly shaken up and made, move 
him on to it, and make the other. Be very careful to get 
plenty of feathers in the middle of the bed. This can only 
be done by moving the sick person quite to the edge of 
each side. Some one should always stand by him to pre- 
vent accidents, or the fear of them, which might do harm. 
Put plenty of feathers under the pillows. 

17. To make up a bed for a person who is very sick 

1 Put draw-sheet on bed. 



LECTURE I. 7 

and cannot be got out for anything, lay a mackintosh 
o\er the bottom sheet, and the draw-sheet over the mackin- 
tosh so that it covers it. 1 If you have no mackintosh a 
piece of oilcloth, or even some thick brown paper under 
the draw-sheet, will help to protect the bed. Paper must 
be taken away and burnt once it has got wet. 

18, To change the under-sheet for a person who can be 
turned on his side, first roll the clean sheet lengthways 
to the middle of the sheet. Turn the sick person on his 
side, roll up the under-sheet lengthways, and tuck it as 
far under the sick person and the pillow as you can. Then 
lay the clean sheet on the bed, see that there is enough to 
tuck in at the side and at each end, and tuck the roiled 
side under the sick person, against the rolled up soiled 
sheet. Turn him over on to his other side and on to the 
clean sheet, draw away the soiled sheet, and pull the roll 
of clean sheet out, lay it smooth and tuck in. 2 Be careful, 
in all changing of sheets, not to uncover the sick person. 
You may turn the heavy covering off, and double the rest 
back over him, if he cannot bear the weight of the whole. 

19. To change the bottom sheet under a person who 
cannot be turned on his side, first untuck the soiled sheet 
and roll it down from under the pillows, roll the clean 
sheet from bottom to top, leaving enough to tuck in at the 
head, lay it straight in the middle, tuck well in at the 
top, and unroll as far as the roll of soiled sheet. Two 
people must stand, one at each side of the bed. One 
hand of each must be clasped under the sick person's back, 
to raise him bit by bit, while with the other hand they 
tuck away the soiled sheet and unroll the clean one. At 
the foot of the bed pull the soiled sheet away and tuck 

1 Make bed up as described. 

2 Change the sheet as described. 



8 HOME NURSING OF THE POOR. 

the clean sheet well in. Be careful to pull the sheet 
smooth as you unroll it, and do not uncover the sick 
person. 1 

20. To change the top sheet with a person in bed, first 
untuck all the bed-covering, lay the clean sheet over 
the bed-covering, and if it is cold weather, or the sick- 
ness is rheumatism, or the chest, or anything where a chill 
is feared, lay a blanket over the sheet, then hold the 
clean sheet up with one hand, while you pull the bed- 
covering down with the other. At the foot of the bed 
pull them out and arrange them over the clean sheet, 
leaving the soiled sheet off. If you have not a spare 
blanket you can take one, or the counterpane, off the top 
before you begin. 2 

21. To change a nightshirt 3 for a helpless person in 
bed, first draw it from under him, and up towards his 
neck. Take one arm out of the sleeve, and get the head 
through the neck-hole by gathering the loose part up in 
one hand, lifting the head with the other, and drawing 
the shirt over it, and away from under it. Put the free 
arm into the sleeve of the clean shirt, and draw the shirt 
over and under the head. Draw the soiled shirt off the 
other arm and from under the sick person's shoulders. 
Put the other sleeve of the clean shirt on, and turn the 
sick person a little on his side so that you can pull the 
clean shirt down comfortably. 

22, If one arm is injured in any way always take it out 
of the sleeve last and put it in first, because it is much 
easier to take out the second arm and put in the first. 

23, If a person cannot be turned on his side get the 

1 Change the sheet as described. 

2 Change sheet. Take a blanket off first and put on the top. 

3 Change nightgown (over clothes). 



LECTURE I. 9 

clean shirt down, with hands clasped under his back, as 
already described for changing a sheet in the same case. 1 

24, A person who can use his arms may be most easily 
raised to a sitting position in bed by clasping his arms 
round your neck. Or you may take his hands in yours 
and pull him up. 2 

25. To raise a helpless person higher in the bed two 
people are required, one at each side. Both must grasp 
the draw-sheet with one hand, close to the heaviest part 
of the sick person, and clasp the other hands together 
under his shoulders. Then lift both together. Be careful 
to take hold of the draw- sheet and to clasp hands low 
enough, so as to raise and not drag. 3 Never drag a help- 
less person or drag anything under or away from him. 

Questions on Lecture I. 

1. What three things are most necessary in a sick 
person's room ? 

2. Why is fresh air so necessary in a sick-room? 

3. Tell all you know about the blood, from the time 
when it leaves the heart to the time when it first comes 
back to the heart. 

4. What happens to the blood after it has come back 
to the heart ? 

5. Why must we have fresh air from outside to be 
healthy ? 

6. What happens if people stay in a room where no 
fresh air can enter ? 

7. How often and how much should a sick person be 
washed ? 

8. How would you wash the feet of a person in bed? 

9. How would you wash a person all over in bed? 

1 Do this. 2 Do both. 

3 Do this. Also show what is meant by dragging. 



10 HOME NURSING OF THE POOR. 

10. Tell me all you know about feeding sick people. 

1 1 . Tell me all you can remember of the care you 
would take for the quietness and comfort of any one very 
ill in bed. 

12. Say all you know about opening the windows in a 
sick-room. 

13. How would you prevent a draught if the bed were 
between the door and the window ? 

14. How often should a sick person's bed be made? 
Should he always be got out of bed ? 

15. What do you mean by a draw-sheet? What 
are its uses? 

1 6. How would you make a large feather-bed with a 
person in it ? 

17. How would you make up a bed for a bad case? 

18. How would you change the under-sheet for a 
person who can be turned on his side ? 

19. How would you change the under-sheet for a 
person who cannot be turned at all ? 

20. How would you change the top sheet over a person 
in bed ? 

2 1 . How would you change a nightshirt for a helpless 
person in bed ? 

22. If you changed a nightshirt for a person with an 
injured arm, which arm would you take the sleeve off 
first ? And on which arm would you put the sleeve first ? 

23. How would you get the clean shirt down under 
a person who cannot be turned at all? 

24. How would you help a person to raise himself to 
a sitting position if he can use his arms? 

25. How would you raise a quite helpless person higher 
in the bed ? Tell me what special care you must take in 
doing this. 



LECTUEE II. 

THE DOCTOR— PREVENTION AND TREATMENT OP BED- 
SORES. 

Things Eequibed for Lecture II. 

1. Bed, bedding and patient as in Lecture I. 

2. Shape and size of a water-bed and water-pillow 
in double brown paper. 

3. Air-cushion and cover. 

4. Old nightgown to tear up the back. 

5. Extra pillow, blanket and sheet. 

6. Some old pieces of sheeting ; plenty of white clean 
rag. 

7. A pad made and another not stuffed. Wadding. 

8. Pail. Jug. Basin. Knife. 

9. Safety pins. Ointment. 

10. Mackintosh. 

11. Some large pieces of paper. 

Note. — Lay everything ready in the order in which you will want 
it. 



(ii) 



LECTURE II. 

26, 1. Tell the doctor all you know about the causes of 
illness, and all you have noticed about the illness, when he 
first comes. 1 The more he knows the better he can judge 
what the illness is, and how to treat it. Make out all you 
can before he comes, and make up your mind what you 
should say, so that you may neither forget nor waste time. 

27, 2. Between the doctor's visits notice anything fresh 
in the sick person's state, such as sickness, sleepless- 
ness, pain, wandering, or anything different. Be sure to 
tell the doctor, even if these changes have passed before he 
comes. If the medicine or food has not been taken for 
any reason you must be sure to mention that too. If you 
are not sure whether anything that the sick person does 
or that you do for him is right, ask the doctor. 

28, 3. To deceive the doctor in any way is not fair to 
him or to the sick person. If you pretend that the medicine 
and the amount of food ordered have been taken when 
they have not, or if you allow the sick person to take 
food or drink, to get out of bed, or do anything that the 
doctor forbids, or if you don't take the trouble to re- 
member and tell any changes you have noticed, how can 
the doctor know how the sick person really is, or whether 
the medicine he has given or the treatment he has ordered 
are doing him good ? 

1 If the audience is equal to making notes for the doctor suggest 
it. 

(12) 



LECTURE II. 13 

29, 4. Truthfulness and obedience to the doctor are 
necessary in nursing. It is both stupid and conceited to 
think you know better than he does. He has spent 
years in learning about the human body and disease, and 
has a reason for all he orders. Hospital nurses, who 
learn their work for years, and have to know a great deal, 
would be sent away in disgrace if they disobeyed the 
doctor or did not tell him all the truth. The sick person 
is bound to suffer if the doctor is disobeyed or deceived. 

30, 5. When any one has to lie in bed, pressure against 
the bed may cause a bedsore. There are three stages in 
a bedsore. First, the skin is red, secondly, the skin 
breaks, thirdly, there is a sore place that matters, gets 
deeper and deeper and is very painful. 

31, 6. To prevent bedsores, relieve the pressure, wash 
the back and hips, and rub in methylated spirits ; keep 
the bed smooth and dry. 

32, 7. The best way to prevent pressure is to use a 
water-bed, water-pillow or air-cushion. To change the 
position frequently is another way, never leaving the 
sick person on his back or on the same side more than a 
few hours at a time. If he is obliged to lie on his back 
always, shift him ever so little, even half an inch, to one 
side from time to time, and prop the other side with 
pillows. This is no use unless you shift the lower and 
heaviest part of the body, as the worst pressure is at the end 
of the spine. If he is obliged to lie always on one side, 
shift ever so little off the hip-bone. Pads like flat pin- 
cushions, with a hole in the middle for where the bone 
sticks out, will also prevent pressure. 1 

1 Show how to shift patient a very little off the end of the spine 
or the hip-bone. Turn with draw-sheet, and prop middle and 
shoulders with pillows or anything rolled. 



14 HOME NURSING OF THE POOR. 

33, 8. When the bed gets wet or soiled often you must 
put a mackintosh under the draw-sheet, and tear or cut 
the nightshirt up the middle of the back, above the waist, 1 
roll it up out of the way of the wet on either side and 
fasten each side with a safety pin, so as to leave nothing 
under the sick person except the draw-sheet. Small pieces 
of old sheeting, doubled several times, may be laid against 
him in such a way as to save the draw-sheet from the worst 
of the wet or soiling. In these cases it is best to use small 
draw-sheets, an old sheet torn into four, or any pieces big 
enough to cover the mackintosh, and tuck in at the side. 
Never leave anything wet or soiled under the sick person, 
and never drag anything under him or from under him. 

34. 9. Take everything wet or soiled out of the room 
at once. If you are short of draw-sheets wring out those 
that are only wet at once in hot water, hang out to dry ? 
smooth by mangling, ironing or stretching — but they must 
be smooth — and hang by the fire till you want them. It 
shows good management and good sense to keep a supply 
of clean aired linen for such a case. What is soiled should 
be put out of doors in a covered pail, and washed as soon 
as possible. 

35, 10. Any illness that makes a person heavy, thin, 
helpless, unconscious, or liable to make the bed wet, is 
likely to cause bedsores. Those who are obliged to lie 
in one position, or who have any fever, are also liable to 
bedsores. A bad state of the blood from fever makes 
the skin more likely to give way and become sore. 

36. 11. Be very careful to prevent the beginning of a 
bedsore in dropsy, consumption, paralysis, broken leg, 
and typhoid fever. Dropsy makes people heavy, con- 

1 Put mackintosh under draw-sheet. Show how to roll up and 
pin nightshirt torn up to waist. 



LBCTUEB II. 15 

sumption makes them thin, paralysis makes them helpless 
and often wet. Broken legs and typhoid cases are obliged 
to lie flat on their backs. At the beginning of all these 
illnesses the back and hips should be washed and rubbed 
with methylated spirits, night and morning. 

37, 12. In the first stage of a bedsore, which is redness 
of the skin, relieve pressure, wash, and rub gently with 
spirits, and dust with starch powder. This should be done 
night and morning, and as often as the sick person gets 
wet or has his linen changed under him. If he flinches 
from the spirits, look for a break in the skin. 

38, 13. In the second stage, when the skin is broken, 
spread boracic ointment on soft linen 1 and lay on the 
place. Change it as often as it gets wet or dirty, or 
Gomes off. The pressure must be relieved or a bad bed- 
sore will certainly come next. 

39, 14. In the third stage, when there is a mattering 
sore, bathe frequently with bits of soft linen dipped in 
warm water, and dress with ointment spread on linen. 2 
A bedsore like this must be shown to the doctor, and he 
will say what ointment should be used. Nothing must 
press on it, or it will soon become a great hole. I have 
seen holes big enough to get my fist in, and running into 
each other. 

40, 15. It is cruel to let a sick person get a bedsore, 
because it causes great pain. And it generally prevents 
the sick person from lying in the only position in which he 
has been easy. 

41 , 16. It is much easier to prevent the beginning of a 

1 Show how to spread ointment on rag with a knife. 

2 Have bits of rag, basin, and show how to dab wound with a bit 
of wet rag, throw it on to paper to burn, and take a fresh bit each 
time. 



16 HOME NURSING OF THE POOR. 

bedsore than to cure one. Often it is impossible to cure 
them, although care would have prevented them. People 
have been known to die of bedsores who had recovered 
from the illness during which they were allowed to 
come. 

42. 17. In a hospital it is considered a disgrace for a 
nurse to allow a patient to get a bedsore. Any one who 
hears this lecture ought to prevent any one she may nurse 
from getting one, and teach her friends and neighbours 
how to prevent them too. 

43. 18. To fill a water-bed, 1 first make sure that you 
have a copper full of very hot water, and plenty of cold 
water at hand. Two pails and a jug you must have too. 
The water-bed must be on something flat, so if the sick 
person is on a feather-bed you must take it away. If 
there is no mattress you must get a flat board. Lift the 
sick person on to a sofa or another bed, and lay the water- 
bed on the mattress or the board, exactly where he 
will want it. Put the part where you fill it outside, and at 
the foot. Fill it with a jug from a pail. 

44. 19. The water must be just warm enough not to 
chill, and not hot enough to be uncomfortable. The bed 
must be so full that any one lying on it rests on the 
water, not on two thicknesses of india-rubber, with water 
all round. 2 And it must not be full enough to be hard. 
Test it by lying on it yourself, and you will get some idea 
of when it is full enough — only if you are light, and the 
sick person is heavy, he will want more water to keep 
him up. Judge as nearly as you can, and then you can 

1 Get pail and jugs ready ; lay paper shaped like bed in the right 
position ; show how to fill. 

2 Show what happens if the water is all round patient and not 
under him. 



LECTURE II. 17 

add or take from the water, or make it cooler or warmer 
when the sick person is on the bed. 

45. 20. To move a person off a large feather-bed on to 
a water-bed, first lift him on the draw-sheet to the 
extreme edge of the bed, on the side where he is to be. 
Then move the bed half off the mattress, so that the sick 
person is on the other side on half the bed, while you arrange 
and fill the water-bed. Make the bed with under sheet over 
it and pillows, and lift the sick person back on to it on 
the draw-sheet. Pull the feather-bed off on the other side 
and arrange the bed-clothes. 1 

46. 21. If the sick person is on a small bed you must 
draw another bed or a sofa, or two tables with pillows 
and blankets on them, close up to one side. For a helpless 
or heavy person you want four people for this. Two must 
stand beside the bed and two on the other side of the 
table. The under-sheet must be strong. Grasp the sheet 
close to the body at the heaviest parts, and draw and lift 
on to the other bed. If the person is very heavy and quite 
helpless some one must lift the head also. In any case 
take care that the head is moved with the rest of the body 
and is always on a pillow, and that the feet are not 
entangled. Cover him comfortably and leave there till 
the water-bed is filled. Then make the bed with sheet 
and pillow and lift the sick person back on to it. Boll 
the extra sheet away from under him and make all com- 
fortable. 2 

47. 22. A water-pillow is meant to reach about from 

1 Show how to do all this. Put chairs against the side of bed, 
and explain that the audience must think it is a double bedstead, 
and a feather-bed. Explain this very clearly. Never trust to 
imagination more than you must. 

2 Do all this, drawing attention to each point as you do it. 

2 



18 HOME NURSING OF THE POOR. 

the small of the back to the thighs. It must be on a 
mattress or something level. A feather-bed under a 
water-pillow is a very senseless arrangement. Because 
it is uneven, the water in the pillow is generally in the 
wrong place. As the sick person is on the water-pillow 
the feather-bed is of no use to him. As the feather-bed 
cannot be turned or shaken under a heavy water-pillow it 
will be spoiled. Fill the pillow and move the sick person 
as for filling a water-bed, but lay the pillow over the 
bottom sheet, and cover with a mackintosh and a draw- 
sheet well tucked in under the mattress on either side. 1 

48, 23. Try to leave the corner where you fill the bed 
or pillow near the edge of the bed, so that you can let 
water off into a pail without moving anything when you 
want to change the water or make it cooler or warmer. 
If the funnel is not over the edge of the bed put something 
under it thick enough to save the bedding from getting wet. 
Foresee and prevent any accident of any sort that will oblige 
you to move the sick person about unnecessarily. 2 That 
is a great sign of clever nursing, and sometimes makes the 
difference between the sick person getting better or not. 

49, 24. An air-cushion is useful for people who cannot 
move at all, or who have sense and strength enough to keep 
it in the right place. The tender or sore part (which is gener- 
ally the end of the backbone, or the hip) must be in the hole. 
A helpless or unconscious person who can move is apt to 
shift himself so that the sore or tender part is on the edge 
of the air-cushion, causing pain and chafing the skin. If 
one is used in such a case some one must be always on 

1 Show how to place the pillow. Show what would happen on a 
feather-bed. Cover with mackintosh and draw-sheet, smooth and 
well tucked under mattress. 

2 Do all this, drawing attention to each point. 



LECTURE II. 19 

the watch to keep it right. Fill the cushion by blowing 
into it and covering with your finger between breaths ; 
screw quickly when it is full enough to keep the sore part 
from touching anything. Make two covers of any old 
calico or linen, tied with tapes underneath, and leaving hole 
empty. 1 Lay over draw-sheet and put a pillow above and 
below, so that the sick person lies level. 

50. 25. Pads, 2 like air-cushions, are useful for people 
who cannot move, or who have sense and strength enough 
to keep them in the right place. If you put one under 
a person who is restless and helpless it will be sure to 
shift into the wrong place — very likely just where the 
hard edges will hurt the sore place. To make a pad for 
the end of the spine, the hip-bone, or a sore place, cut a 
round of calico, or any white material that you have, 
doubled. Cut a hole in the middle and sew the edges to- 
gether, making a round hole. Then stuff the ring all 
round with wadding, just enough to keep the bone or sore 
part off the bed. Tack round roughly because, as soon 
as it gets wet, you must take the stuffing out, wash and 
refill. Two covers and half a yard of cheap grey wad- 
ding will last a long time. 

Questions on Lectuee II. 

26, 1. What should you tell the doctor when he comes 
first ? And what should you do before he comes ? 

27. 2. What should you notice between the doctor's 
visits ? What should you tell him and ask him at each visit ? 

1 Fill. Put cover off and on. Arrange with pillows on bed. To 
make cover, cut a Iwle in a double piece of calico the shape and size of 
cushion ; sew round inside of hole. Tack strings on outside and tie 
on to cushion. 

2 Show a pad made. Have another cut out and show how to 
make. You need not stuff it all nor sew it. 



20 HOME NURSING OF THE POOR. 

28. 3. What harm is done if you deceive the doctor, 
or don't take the trouble to remember and tell him what 
changes you have noticed in the sick person ? 

29. 4. Why is it both stupid and conceited not to obey 
the doctor's orders and not to tell him all the truth? 
Give all the reasons you can remember. 

30. 5. What causes a bedsore? What are the three 
stages ? 

31. 6. What can be done to prevent bedsores ? 

32. 7. Tell me three ways of relieving pressure from 
the bed. What would you do for a person obliged to lie 
on his back or on one side to save the hip-bone, or the 
end of the spine ? 

33. 8. Tell me all the care you would take in a case 
where the bed often gets wet or soiled. 

34. 9. What would you do with wet or soiled bed-linen 
in an ordinary case when you took it off the bed? How 
would you keep a clean dry draw-sheet always ready if 
you were short of them, and the bed got wet constantly ? 

35. 10. What sort of cases are most liable to bedsores? 
Say the sort of illness, not the names of any special com- 
plaints. 

36. 11. Mention the names of five illnesses in which 
you should take care to prevent bedsores from the begin- 
ning. Say why each illness you mention is likely to 
cause bedsores ; and what you would do to prevent them 
in all these cases. 

37. 12. Say all you would do for a bedsore in the first 
stage — redness of the skin. 

38. 13. Say all you would do for a bedsore in the second 
stage — broken skin. 

39. 14. Say all you would do for a bedsore in the 
third stage — a mattering sore. 



LECTUKE II. 21 

40. 15. Give two reasons why it is cruel to allow a sick 
person to get a bedsore. 

41. 16. Is it easy to cure a bedsore? Say all you 
remember about this. 

42. 17. What is thought of a hospital nurse who allows 
a sick person to get a bedsore ? What ought all who hear 
the lecture to be able to do ? Say all you remember. 

43. 18. What would you have ready before you began 
to fill a water-bed ? What must it be laid on ? Tell me 
how you would place the water-bed before you began to 
fill it. How would you fill it ? 

44. 19. How warm should the water be for a water- 
bed ? How much should you put in ? Say all you re- 
member about filling the bed (not about moving the sick 
person). 

45. 20. How would you move a sick person off a large 
feather-bed on to a water-bed? Say all you can re- 
member. 

46. 21. How would you move a person who is in a 
small bed on to a water-bed ? 

47. 22. About how much of a sick person should lie on 
a water-pillow ? Why should you not put a water- pillow 
on a feather-bed ? What should be under and what over 
a water-pillow? 

48. 23. Why should the corner where you fill a water- 
bed or pillow be at the edge of the bed ? What special 
care would you take in letting water out, or putting more 
in, if the funnel is not clear of the bed ? What sort of 
accidents does a clever nurse prevent ? 

49. 24. In what cases are air-cushions useful? Say all 
you remember about filling, covering and placing them. 

50. 25. In what cases are pads useful ? Say how you 
would make them, and all you remember about them. 



LECTUEE III. 

POULTICES— FOMENTATIONS— DRESSING OP WOUNDS- 
DANGERS OP QUICK HEALING AND QUACK 
REMEDIES. 

Things Requieed foe Lectuee III. 

1. Plenty of clean white rag. 

2. Old sheeting or towels to tear into .bandages. 

3. Flannel enough for covering and fomentation. 

4. Towel or cloth for wringer. 

5. Linseed meal. Ointment. Safety pins. 

6. Two jugs of water. Two basins. A knife. 

7. An old pail or pan. A little kettle (a spirit lamp if 
there is no fire). 

8. Two pairs of scissors. 

Note. — It is worth having oil-silk and wool to show their ad- 
vantages to those who can get them. 

I believe it is best to teach poor people to keep dressings and 
applications on and up with any sort of broad bandage they have 
to use. If any special sort of bandaging is taught, whole lectures 
must be given to that subject, as of course each pupil must do it 
to learn. 



(22) 



LECTUEE III. 

51, 1. If a linseed poultice is ordered, four things are 
necessary to make it useful. It must be (1) hot ; (2) the 
right size ; (3) in the right place; and (4) must be kept 
in the right place. 

52, 2. If the doctor orders a poultice, ask him (1) 
how big it is to be ; (2) how long you are to keep on 
poulticing'; (3) how often the poultice is to be changed. 

53, 3. Before you begin to make a linseed poultice see 
that you have ready boiling water, linseed meal, a 
basin, a knife, a piece of linen the right size for the 
poultice, flannel (if you cannot get oil-silk or wool) to 
cover it with, a handkerchief, towel, piece of linen, 
or anything large or long enough to bandage it on with, 
and some safety pins. 1 

54, 4. Lay the piece of linen ready on the table. Pour 
a little boiling water into the basin to warm it, and the 
knife in it. Throw the water out and pour in what you 
think will be enough to make the poultice. Throw in 
handfuls of Unseed meal and stir quickly till it is thick 
and mixed enough to turn out clean. Turn out on to the 
linen, spread evenly and quickly about a quarter of an 
inch thick, turn down the edges of the linen all round. 
Eoll it up to carry to the sick person. If the poultice 

1 Show all these. 

(23) 



24 HOME NURSING OF THE POOR. 

is to go on an open wound, lay a piece of clean muslin 
over it before you turn down the edges. 1 

55, 5. To keep any sort of poultice or fomentation on 
the back or chest use a broad piece of anything clean for 
the bandage, and tear down a little way where each arm 
will come. Then, when you have fastened the bandage 
safely, in front or at the side, fasten it over each shoulder 
with a safety pin. To keep any poultice or fomentation 
up on the neck you must bring the bandage over the 
head. 2 For the thigh you must bring it round the waist. 
For the leg you must bring it over the knee. For the 
forearm take your bandage over the elbow. For the 
upper part of the arm take it round the neck. 3 Use a 
bandage broad enough to cover whatever you want to keep 
on, and so long that, when you have split it at both ends, 
you will have enough to tie it round below, and take the 
upper ends where I have told you they must go. Poultices 
and dressings in the wrong place are of no use. 

56, 6. A linseed poultice is generally changed every 
four hours. When you have all ready to make it, unfasten 
the bandage over the one to be taken off, and any garments 
that are in the way. Then leave the poultice on and the 
sick person well covered while you make the other. 
Bring your poultice rolled up, remove the other, put the 
new one on, cover with flannel (or oil- silk and wool if you 
have it) and fasten with a bandage. 4 

1 Do all this, first without muslin ; then unroll, turn back edges, 
and lay muslin on. Lay great stress on being quick. 

2 Show exactly how to do chest or back over clothing. Also 
neck and arms. 

3 For legs and thigh show as well as you can over clothing and 
explain. Only the simplest easiest way will do. Use safety pins 
too besides tying. 

4 Show how to do all this with sham poultice. 



LECTUEE III. 25 

57, 7. Never remove the old poultice till the new one 
is ready to put on. Never put a very hot poultice on 
suddenly. It should always be hotter than the sick person 
can bear all at once. If he is well enough let him press 
it against his skin as he can bear it, you holding it. If he 
is sensible let him guide you in putting it against him, 
hold it close, and get it on gradually. 1 If you make the 
skin sore so that the sick person cannot bear more poultice 
you do great harm. If the poultice is not very hot it is 
not much good. So be careful. Take special care with 
babies and unconscious or paralysed people. When you 
leave off poulticing back or chest lay flannel or wool 
where the poultice was (unless the sick person wears a 
flannel nightgown or vest). 

58, 8. If you are short of rag, and the poultice is not 
on a sore place, lay it in cold water when you take it off. 
Then all the linseed will peel off, and you can wring the 
rags out in hot water and dry them. Never use the same 
linseed again. Burn poultices off open sores just as you 
take them off. 

59, 9. If the doctor orders a fomentation ask him how 
often it is to be changed, and if you are to go on with it 
till he comes again. If it is for some gathering or 
swelling you will know how much you have to cover. 
But if it is for something you cannot see, ask about the size. 
Be quite clear in your own mind how big the fomentation 
should be before you make it. 

60, 10. To make a fomentation, have ready before you 
begin doubled flannel the right size, boiling water, 
a basin, a cloth big enough to lay in the basin with the 
ends outside, double flannel big enough to cover the 

1 Show how to put hot application gradually to the skin. 



26 HOME NURSING OF THE POOR. 

fomentation (if you cannot get oil-silk), something big 
enough to fasten it on with, some safety pins. 1 

61, 11. Lay the wringer in the basin with the ends 
outside. Lay the piece of doubled flannel for the fomenta- 
tion on the wringer in the basin. Pour on boiling water. 
Wring the flannel in the wringer, and carry it in the 
wringer to the sick person. Take the flannel out of the 
wringer, lay it on the flannel (or oil-silk), put it on as hot 
as the sick person can bear it, fasten with bandage and 
safety pins. 2 

62, 12. Hang the wringer to dry between the times of 
changing. Hang the flannels to dry also. Have two 
pieces of flannel for the fomentation, and covering, and 
never take one off till the other is wrung and ready to 
put on, in the wringer. 

63, 13. If you have to dress a wound that requires 
washing see that you have all you will want ready be- 
fore you begin. You will want something that is never 
used for anything else, and that can be broken and thrown 
away when it is done with, for the dirty water, a thick 
piece of paper, in which you can afterwards burn them, 
for the used dressings, some boiled water, both hot and 
cold, a lot of little bits of soft clean rag, and whatever 
dressing is ordered, ready to put on. 3 

64, 14. If a poultice or fomentation is ordered for an 
open sore, you must have everything ready to make 
them, especially boiling water, before you wash the sore. 
Then cover it with a piece of clean dressing while you 
make the poultice or fomentation. 

1 Show all these things. 

2 Do all this ; but you need not use any water. Show how to 
take out of wringer and apply. 

3 Show all these. 



LECTURE III. 27 

65, 15. If the dressing you take off is very dirty, keep 
a pair of scissors to get hold of it instead of touching it 
with your fingers. If the dressing sticks, never pull it off 
roughly. Drip warm water on it from one of the bits of 
rag, and loosen gently till it comes off, 1 

66, 16. When you dress an ulcerated leg or foot that 
discharges a great deal and is very dirty you can put 
something under it, and pour very gently some warm 
water over it to clean it a little. Then dab with the bits 
of rag dipped in the basin of clean water till the wound is 
clean. Never dip the same bit of rag in the water twice. 
When you have used each piece once, throw it on to the 
piece of paper to be burned. 2 The water in the basin 
must be as clean when you have finished washing the wound 
as it was when you began. Sores and wounds are gener- 
ally washed entirely by dabbing. Only very old dirty 
ones can have water poured over them. 

67, 17. If you wash a wound for a person in bed, put 
something under it thick enough to keep the bed dry. 

68, 18. If you use ointment spread a good bit while 
you are about it, keep it folded, 3 ointment to ointment, and 
cut off pieces the right size as you want them. Use 
pieces the size of the wound, neither too small nor too big. 
Fasten with some sort of bandage, according to where the 
wound is. 

69, 19. Never take the dressing off a wound to show 
it to any one unless you are obliged. Never, in any case, 
put the same dressing against the wound if you have 
taken it off for an instant. Never leave a wound un- 
covered. Never rub a wound to wash it. Dab it. 

70, 20. If the doctor has dressed a wound after an 

1 Show how to do this, holding dressing with scissors. 

2 Show how to do all this. 3 Spread and fold. 



28 HOME NURSING OF THE POOR. 

operation or an accident, ask him exactly what you are to 
do before he comes again, and do not meddle with any- 
thing without his leave till he comes back. If blood or 
matter come through the bandage, or if the pain increases 
very much, you had better let the doctor know. 1 If you 
cannot go yourself take care that whoever goes gives the 
right message and brings the right order back. Mistakes 
are dangerous. 

71. 21. Eemember that whatever touches an open 
wound may be carried straight into the blood and may 
poison the wound. Hands and nails must be well washed 
and brushed before you begin to dress a wound, rags 
washed and boiled, basins scalded out. In water there 
is what may poison open wounds, so use boiled water. 
The air may poison wounds, so uncover them as little as 
possible. Keep all dressings, rags and everything else 
covered with a clean cloth in a clean place. 

72. 22. It is very dangerous to heal up an old wound 
or any sort of sore without a doctor's advice. It is gener- 
ally necessary to take some special means to cure what 
causes the sore or old wound in the blood while it is being 
healed outside. Quick healing of the sore, without any 
treatment for what causes it in the blood, may simply seal 
up the opening that lets poison out, and drive it into the 
blood. 

73. 23. Blood-poisoning may cause a rash or sores all 
over the body or perhaps on the face. It may cause a 
very long and dangerous illness, or it may cause death 
in a few days. 

74. 24. Quack medicines are dangerous because in 
curing something outside they may do some great harm 

1 Make a great point of sending some one reliable, or if possible 
going oneself to the doctor. 



LECTURE III. 29 

inside. Diarrhoea may be getting rid of some poisonous 
stuff. A cough may be the one thing that saves some one 
from being choked with phlegm. A quack medicine 
stops the diarrhoea and drives the poisonous stuff into 
the body, or stops the cough and the phlegm stops up 
the air-tubes. 

75, 25. The difference between going to a doctor and 
going to a quack (or buying patent medicines) is this : 
A doctor understands the working of the whole human 
body, and takes care that the remedy he gives to cure one 
complaint does not cause another. You or the quack 
doctor cure the complaint, and run the risk of causing 
something worse, or your death. (I remember a case of a 
young woman near my district dying suddenly from the 
effects of the same dose of the same drug that cured my 
complaint. She had dosed herself.) 

Questions on Lecture III. 

51, 1. Say what four things are necessary to make a 
linseed poultice useful. 

52, 2. If the doctor orders a linseed poultice, what 
three questions should you ask him? 

53, 3. Before you begin to make a linseed poultice, 
what should you have ready? Say all you remember. 

54, 4. Say exactly how you would make a linseed 
poultice. What difference would you make in one that 
was for an open wound? 

55, 5. Say how you would keep a poultice or fomenta- 
tion up on the neck, back or chest, thigh, leg or arm. 

56, 6. How often is a poultice generally changed? 
Say exactly how you would set about changing one. 

57, 7. Would you take one poultice off before you make 
the other ? What care would you take not to put it on too 



30 HOME NURSING OF THE POOR. 

hot ? In what cases must you take special care not to put 
it on too hot? What must you do when you leave off 
poulticing the back or chest? 

58. 8. What may you do with a poultice that is not off 
a sore place ? May you ever use the same linseed twice ? 
What would you do with a poultice taken off a sore place ? 

59. 9. When the doctor orders a fomentation what 
questions should you ask him? Say all you remember 
about this. 

60. 10. What would you have ready before you began 
to make a fomentation ? 

61. 11. Say all you remember about how to make a 
fomentation, and how to put it on. 

62. 12. What would you do with the wringer and flan- 
nels between changing the fomentations ? Why should 
you have two pieces of flannel both for the fomentation 
and for covering it? 

63. 13. Say all that you would have ready before you 
began to dress a wound that required washing. 

64. 14. If you have to wash a sore or wound that is 
being poulticed or fomented, say exactly what you would 
do first, and how you would do it all through. 

65. 15. If the dressings you take off a sore are very 
dirty, what had you better use ? What would you do if a 
dressing stuck ? 

66. 16. How may you begin to wash a very dirty ulcer 
on a leg ? Say exactly how you would use the little 
bits of clean rag. May you leave the water you have been 
using in the basin soiled ? 

67. 17. What would you do before you began to wash 
a wound on a person lying in bed? 

68. 18. Say all you remember about ointment dress- 
ing. 



LECTURE III. 31 

69, 19. Say four things that you must never do when 
you have the care of any wound or sore. 

70, 20. Say all you remember of what you ought to 
do and ought not to do when the doctor has dressed a 
wound after an operation or an accident. 

71, 21. Why must you be so careful about cleanliness 
in dressing a wound? Say all the care you would take. 
Why should water be boiled ? Why should a wound not 
be left uncovered ? 

72, 22. Why is it dangerous to heal up an old wound 
without a doctor's advice ? Say all you remember about 
this. 

73, 23. Say all you know about what may come of 
blood-poisoning. 

74, 24. Why are quack medicines dangerous? Say 
all you remember about this. 

75, 25. Why is it safe to go to a doctor for treatment 
and not safe to go to a quack, or buy patent medicines ? 
Say all you remember. 



LECTUEE IV. 

TYPHOID, WHAT IT IS, AND HOW TO NUBSE IT. 

Things Required for Lecture IV. 

1. Rough diagram of the intestinal canal. 

2. Feeding-cup. 

3. Higgin's syringe. 

4. Jug of hot water. 

5. Soap, vaseline, towel. 

6. Bits of rag. 

7. Diagram 1. 



(32) 



LECTUEE IV. 

76. 1. One caution I must give you at the beginning 
of this lecture on typhoid fever, and it applies equally 
to all I tell you about what nurses should or should not 
do. I give you the general nursing rules. In every case 
the doctor gives special orders, which may sometimes 
contradict all ordinary and general rules. Remember 
that there are often special dangers that have to be met by 
special treatment, or some fresh discovery concerning 
the disease and its cure of which you know nothing. 
Obey the doctor, as a soldier obeys his officer. Never 
forget that he has not only to cure the disease you know 
of, but to foresee and prevent evils of which you know 
nothing. 

77. 2. To understand what typhoid fever is, you must 
know something about the intestines. And to understand 
the reason for very careful nursing, you must also know 
something about the digestive system. This picture l will 
make both plain to you. There is the gullet, down which 
the food goes, after it has been chewed and softened in 
the mouth, into the stomach. There are the small in- 
testines, into which the food goes after it has been changed 
very much, mostly into fluid, in the stomach. There is 
the large intestine. What goes there is chiefly what is 

1 Show '.the diagram. 

(33) 3 



34 



HOME NURSING OF THE POOR. 



undigested and cannot be digested. That is what passes 
away through the bowels. 

78, 3. By " digestion" we mean the changes that 




take place in the food we have eaten, when it is in the 
stomach and intestines. These changes are made by 
certain juices that mix with the food, changing hard 
substances into fluids and so on. In many sorts of illness 



LECTURE IV. 35 

these juices do not act properly, and that is why solid food is 
forbidden. " Indigestion " means that the food is not so 
changed that what is good nourishes the body, and what 
is useless is passed out. 

79. 4. If the intestines were spread out they would be 
about thirty feet long. They are like tubes of tough skin, 
and the stomach is like a bag. As the food passes slowly 
along the intestines, what is good for nourishment soaks 
through, as ink soaks through blotting-paper, and is 
taken up by tiny blood-vessels, and passes by degrees 
into the large blood-vessels that you have seen. 1 Good 
food, well digested, makes good blood. Fresh air keeps 
blood clean. 

80. 5. Typhoid fever means ulcers on the small in- 
testines. An ulcer is a mattering sore that keeps getting 
bigger and deeper. An ulcer can only heal if the part that 
it is on is kept still. (You know how a " bad leg," which 
means an ulcerated leg, must be kept up and at rest if 
the leg is to be healed.) 

81. 6. Ulcers on the intestines make thin places, and 
anything hard pressing against those thin places might 
make a hole, when the sick person would almost certainly 
die. Even the pip of a grape has been known to cause 
death in this way. Or, because digestion does not go on 
properly when any one has this fever, any food that dis- 
agreed might cause diarrhoea or sickness, working and 
straining the intestines, making the ulcers bigger, and 
perhaps causing a thin place to give way. 

82. 7. You will understand now that the very first rule 
in nursing typhoid fever is to give nothing, either to eat or 
drink, but what the doctor has quite distinctly ordered. 

1 Show diagram of circulatory system again. 



36 HOME NUBSING OF THE POOR. 

The second rule in feeding is to give all he does order, or 
the sick person may die of exhaustion. The third rule is, 
have a regular system of giving the food. Divide the 
quantity to be given into so much every two or three 
hours. Ask the doctor how often to give the food. It 
makes a difference, and must be given according to the 
condition of the person. 

83. 8. Use a feeding-cup 1 (don't forget to tuck a cloth 
under the chin). If the sick person is too ill to raise his 
head and hold the cup, be very careful not to choke him. 
Directly you have given the drink rinse the feeding-cup 
well (especially the spout) and lay it in a basin of clean 
water till you want it again. 

84. 9. In a bad case of typhoid fever there comes a 
time when the sick person seems to be always asleep, and 
cannot bear to be disturbed. At that stage he must be 
roused enough to take his food at regular times. Often, 
if you are firm in telling him that you dare not let him go 
to sleep again till he has taken the food, he will take it in 
order to be allowed to sleep. But there may be a time 
when a quiet undisturbed sleep makes the turn towards 
recovery. So ask the doctor whether or not you are to 
waken the sick person to feed him. Ask as often as you do 
not feel sure, on account of some change. 

85. 10. Never let a sick person's teeth or tongue or 
lips get coated with brown stuff. A person with typhoid 
must have his mouth washed out night and morning. 
Use glycerine and borax, or borax in water. (Some 
people cannot bear the sweetness of glycerine.) Wrap a 
bit of clean rag round your finger, 2 dip it in whatever you 
use, and clean the tongue, teeth, lips, in fact the whole 

1 Show a feeding-cup and lay stress on keeping the spout clean. 

2 Show rag on finger, and bits of rag, and piece of paper ready. 



LECTUEB IV. 37 

mouth. When you have used the bit of rag once put it on 
a bit of paper, laid ready, to be burnt at once. In a bad 
case you must wash the mouth out after each feed. (To 
keep a sick person's mouth clean and nice is a sure sign of 
clever and careful nursing.) 

86, 11. You will understand, too, why a person who 
has typhoid fever must be kept lying down in bed. 
Movement prevents the ulcers from healing : it may also 
cause a thin place to give way : there is also danger of an 
ulcer eating into a large blood-vessel, 1 and any movement 
increases the danger of the breaking of a blood-vessel in- 
side the body. Therefore, the second great rule for nurs- 
ing typhoid fever is, keep the sick person lying down in 
bed till the doctor says he may sit up or get out. 

87, 12. Have your bedpan always at hand ; thoroughly 
clean {especially the spout if it is a round one, and the toe 
part if it is a slipper) and with a little disinfectant in it. 
If the sick person is helpless and heavy you must have 
some one on the other side of the bed to help you. Clasp 
hands under the end of the spine and raise enough not to 
scrape the skin while you put it under or take it away. 
Directly it is used, add more disinfectant in the room, and 
empty it at once. (Notice what the motions are like, as 
the doctor will want to know.) 

88, 13. Take all the care you have already learnt to 
prevent bedsores. Take special care of the shoulder- 
blades and the end of the spine. Keep a draw-sheet and 
mackintosh under the sick person, and make the bed as 
you have learnt, moving him from side to side. Ask the 
doctor if he is to be washed all over every day, and do as 
you learnt in the first lecture. Keep his hair combed, 
and his nails cut and clean. 

1 Point to blood-vessels on diagram. 



38 HOME NURSING OF THE POOB. 

89, 14. Typhoid fever is not catching, like scarlet fever 
or small-pox. But it may be taken from another person 
(1) if food is touched with unwashed hands by a person 
who is nursing typhoid ; (2) if anything that comes from 
the sick person is left about so that the air gets tainted 
and taints the food ; (3) if motions are not thoroughly dis- 
infected before the bedpan is taken out of the room. (If you 
leave it about, you taint the air. If you empty it without 
disinfecting it, you may start an epidemic of typhoid.) 

90, 15. Keep a basin of water, with disinfectant in it, 
in the room, and dip your hand in it before you leave the 
room. Put all soiled linen into disinfectant before you take 
it out of the room. Pour disinfectant over the motion 
before you take it out of the room, and empty at once. 

91, 16. Unless you use enough of any sort of disin- 
fectant it does not kill the infection. A strong smell does 
not mean that it is enough. Therefore ask the doctor how 
much of whatever sort of disinfectant you get must be 
used in each case, and use enough. It is generally given 
for typhoid cases at the sanitary offices. 

92, 17. Most likely you will have to give enemas, that 
is, injections into the bowel. You must have ready some 
hot water, yellow soap, a basin (rather a deep one is best), 
a thick towel or piece of old sheeting, a little vaseline 
and a syringe. 1 

93, 18. Rub plenty of soap into about two pints of 
warm water. Pass some of this several times through 
the syringe, 2 and be sure that there is no air but all 
water in your syringe before you begin to use it. Vaseline 
the nozzle. The sick person must lie on his left side at 
the edge of the bed, with his knees drawn up. Tuck the 

1 Show all you mention. 

2 Show preparations of soap suds and syringe. 



LECTURE IV. 89 

towel a little under him in case of any accident. Put the 
nozzle into the opening into the bowel very gently, a little 
backward and upward. {Take care that the other end of 
the syringe is always in the water. 1 Squeeze the bulb of 
the syringe gently and slowly.) If the sick person says 
he cannot bear it, wait a little and go on again. If it 
comes back, hold a fold of the towel pressed against where 
the nozzle is. Be very slow and gentle. Generally you 
can inject a pint and a half. (Stop before the basin is 
empty or you will inject wind.) 2 Persuade the sick person 
to wait as long as he can for the bedpan. If he has not 
sense or strength to make any effort, hold the folded 
towel pressed against the part for a few minutes before 
you give the bedpan. Clean the syringe thoroughly and 
disinfect it. 3 It must not be used for other cases. 

94. 19. If the diarrhoea becomes much worse, or comes 
back after it has left off, if the sick person turns much 
hotter or more delirious, or if you notice a little blood 
with the motions, send word to the doctor if you are not 
expecting him directly. These may be very bad symptoms. 

95, 20. If a person with typhoid has a sudden increase 
of pain and swelling of the body, and seems weak and 
sinking, keep him still, and send for the doctor at once. 
If he turns pale and giddy, feels sick, turns cool suddenly, 
and breaks out in cold perspiration, or seems to have 
difficulty in breathing, keep him still, give no stimulant, 
and send for the doctor at once. In both cases ivrite or 
send word by some reliable person what has happened.* 

1 Show how to work the syringe and what happens if the other 
end is out of the water/ 

2 Show this. 3 Show how to clean the syringe. 

4 With time and a suitable audience it is worth while to explain 
the meaning of these symptoms. 



40 HOME NURSING OF THE POOR. 

96. 21. Be very careful when a person with typhoid 
begins to get better. He will be dreadfully hungry and 
feel much better than he is. Therefore he will beg for 
food that he may not have, and want to do things he 
must not do. If you let him sit up, get out of bed, walk, 
or take any sort of food or drink, or a quantity of food, 
without the doctor's leave, you risk his life. 

97. 22. The two dangers to a person getting better of 
typhoid fever are, causing the whole illness to begin over 
again, or breaking through the thin places of the intestine. 
Unsuitable food or exertion may cause either of these results. 

98. 23. Even when the sick person is fairly well and 
about again it is wise to avoid currants, new bread, and 
anything very hard or indigestible for some time. 

99. 24. When a person begins to get ill with headache, 
no appetite, feverishness and a feeling of being ill all over 
— and more especially if there is diarrhoea or a cough as 
well — remember that it may be typhoid, though it may not. 
In any case it can do no harm to keep the person lying 
down and without solid food till he is better, or till you 
get the doctor. Best and a milk diet will probably cure 
a slight ailment. Keeping about and taking solid food 
may cause the death of a person sickening for typhoid fever. 

100. 25. I have chosen to take typhoid fever at length, 
because to nurse it well you must practise those rules 
which are necessary in all good nursing — obedience, 
regularity, watchfulness. Also everything that you have 
learnt in this lecture will be useful in general nursing. 

Questions on Lectuee IV. 
76. 1. Why will the doctor give orders in particular 
cases that seem to go against the general rules given in 
these lectures ? Give three reasons. 



LECTURE IV. 41 

77, 2. Say where the food goes from the time you eat 
it (I mean while it is in the stomach or intestines). 

78, 3. What do you mean by " digestion," and what 
causes it ? Why is solid food often forbidden in illness ? 
What do you mean by " indigestion " ? 

79, 4. How long would the intestines be if they were 
spread out ? What are the intestines and the stomach 
like ? How does what is nourishing in the food get into 
the blood ? What makes good blood ? 

80, 5. What do you mean by typhoid fever ? What is 
an ulcer ? What is absolutely necessary for the healing of 
an ulcer ? 

81, 6. Say why ulcers on the intestines make improper 
feeding so dangerous. Mention three chief dangers from 
improper food. 

82, 7. What is the very first rule in nursing typhoid 
fever? What are the second and the third rules with 
regard to feeding ? Say all you remember about both. 

83, 8. Say all special care you would take in using a 
feeding-cup, and after using it. 

84, 9. Should a typhoid case be wakened from sleep 
to be fed ? Say all you remember about this, mentioning 
two different stages, and what you would do in each of 
them. 

85, 10. Say exactly what care you would take of a sick 
person's mouth, and especially of one who had typhoid. 

86, 11. What is the second great rule in nursing typhoid 
fever ? Mention three reasons for this rule. 

87, 12. Where and in what state must you always 
have the bedpan ? How should two people lift a helpless 
person on to a bedpan? What must you do directly a 
typhoid case has used the bedpan ? 

88, 13. In a typhoid case, what would you do to 



42 HOME NUBSING OF THE POOR. 

prevent bedsores? How would you make the bed and 
change the bed-linen? How much would you wash a 
person with typhoid ? 

89. 14. Mention three ways in which typhoid fever may 
be given from one person to others. 

90, 15. Say all the care you would take to prevent 
spreading typhoid fever. 

91, 16. What must you make sure of in using any 
disinfectant? How would you make sure? 

92, 17. What must you have ready to give an enema? 

93. 18. Say all you remember about giving an enema : 
from getting it ready to after you have given it. 

94. 19. What changes in a person ill with typhoid 
should make you send word to the doctor if he is not 
coming directly? 

95. 20. Under what circumstances should you send 
for the doctor at once when you are nursing a typhoid 
case, and what should you do and not do till the doctor 
comes in each case ? 

96, 21. What special care must you take when a 
typhoid case begins to get better? Why? 

97, 22. What are the two great dangers to a person 
beginning to get better from typhoid ? What may cause 
either of these results ? 

98, 23. Even when a person who has had typhoid is 
fairly well, what care should he take for some time? 

99. 24. What signs of illness may mean typhoid? 
How should you treat them? Give your reasons. 

100. 25. Why is it particularly useful to learn how to 
nurse typhoid fever? Give two reasons. 



LECTUEE V. 

INFANTS AND CHILDREN. 

Things Required for Lecture V. 

1. Baby's feeding-bottle. 

Note. — If you can conveniently get samples of properly made 
infants' garments, with strings where anything can be tied, it is 
worth showing them, at Section II. (111). 



(43) 



LECTUEE V. 

101. 1. Milk is the only food an infant can digest. 
Nature meant babies to live on milk, so she only provides 
those juices in the stomach and intestines of a baby that 
will change milk into nourishment. 

102. 2. A baby may like bread sop, and seem more 
satisfied with it than with milk for the moment. As the 
bread cannot be digested, that is, changed into nourish- 
ment, it does the baby no good. It is not fair to a baby to 
stop its crying for food with something that is no real 
food. Some babies do manage to live and thrive who have 
a little bread sop. But they would have been spared a 
good deal of wind and pain, and have grown up healthier 
than they are, if they had not been given useless and in- 
digestible food. Some die from it. 

103. 3. Do not give the baby little bits and little 
drops of what you take yourself. They always do it 
harm. Often they cause the ailments that bring its 
death. (I once saw a father giving his baby some of his 
tea and potato. Soon afterwards I saw the baby dead.) 

104. 4. Not to be brought up on its mother's milk is a 
great loss to a baby. The reason why Japanese mothers 
rear more sons than are reared by English mothers, and 
such sons, too, as we have seen lately, is that Japanese 
women are more careful to feed their babies from the 

(44) 



LECTUEE V. 45 

breast — to give them nothing else — and to give them 
digestible food and no meat for long after they are 
weaned. 

105. 5. If an infant must be brought up by hand, use 
a bottle 1 without a tube. Take it to pieces, 2 rinse it, and 
lay it in a pan of clean water between each feed. Long 
tubes seem to save trouble to a busy woman, because the 
bottle does not want holding. But they cause stomach- 
ache, bad nights, and " thrush"; and so cause loss of 
time and sleep to the mother. 

106. 6. Babies ought not to have "thrush" or, as it 
is sometimes called, "red gum ". If, after they are fed, 
their mouths are washed with warm water, as you would 
wash a sick person's mouth, and with a little borax in the 
water if there is any sign of soreness, they would have no 
" thrush ". The soreness of the mouth is caused by want 
of care of the bottle or the mouth. The rash on the 
lower parts is caused either from that soreness coming 
down through the body, or because the baby is not kept 
clean and dry. Never let a baby you have the care of 
get " thrush ". 

107. 7. To prepare a "bottle" for an infant under a 
month old you must mix warm boiled water with the 
milk, a little more water than milk, 3 and add half a tea- 
spoonful of sugar. From the first to the seventh month 
keep giving a little less water and more milk, till, at seven 
months old, it has sweetened warmed milk alone. After 
seven months you may thicken the milk with a little baked 
flour or good, well-baked bread. This must be thin 

1 Show bottle. 2 Take it to pieces. 

3 Explain these are general rules, to be varied under different 
circumstances. For instance, two parts water to one part milk 
may suit some children better. 



46 HOME NURSING OF THE POOR. 

enough to pass through a strainer, and must be given in 
the bottle once or twice a day. Give plenty of good 
sweetened milk besides. 

108. 8. A child should be weaned at about eight or 
nine months of age. It may have some thin broth when 
it is ten months old. It must not have meat till it is a 
year and a half old. 

109. 9. The four great rules for rearing a baby are (1) 
feed it properly ; (2) keep it out of doors as much as 
possible ; (3) wash it all over every day ; (4) keep it dry, 
clean and warm. 

110. 10. If a baby cries and cannot be stopped make 
sure that it is not ivet, cold, or pricked by a pin. See if it 
is chafed anywhere, and if the creases of the skin are well 
dried and powdered. If it seems to have pain in the 
stomach give it a little dill- water mixed with warm water. 
Make sure that the bowels act properly. You may also 
add a little lime water to the milk. 

111. 11. A baby's clothing should be loose, soft and 
warm. Use safety pins. 

112. 12. If the baby suddenly begins to twitch, and the 
twitching keeps coming on, it is dangerously convulsed, 
and you must send for the doctor. Prepare a hot bath 
and put in mustard about a teaspoonful to the gallon. 
Tie the mustard up in muslin or thin rag. The way to 
test the heat of a bath for a baby is with your elbow. 
Your hand is no rule for a baby's tender skin. Put the 
child in the bath, hold its legs, and support its head on 
your arm so that the water does not get into its eyes. 
Keep it in for about five minutes, then wrap it in 
blankets. 

113. 13. Croup may come with a cold or it may come 
on quite suddenly. You will know it by the cough and 



LECTUKE V. 47 

the difficult breathing. Send for the doctor at once. 
Get a hot bath ready and give it, keep the room warm 
(but not stuffy) and a kettle boiling so that it steams 
into the room. (Add boiling, not cold, water when neces- 
sary.) You may also put hot fomentations of doubled 
flannel on the throat. {Remember that a baby's skin is 
very tender and don't scald it.) Prop it up with pillows 
in bed, and try to keep it from crying and coughing. 

1 14. 14. There are two sorts of croup. From one sort 
a child generally gets well. From the other it generally 
dies. As you never know which it is, and the remedies 
you use are the same in each, always act as if it were the 
worst sort. Do not lose a moment in sending for the doctor 
and doing all you can before he comes. 

115. 15. Feeding a sick child is one of the most difficult 
duties of a nurse. Often its life depends on its strength 
being kept up with milk, and it shrieks at the sight of the 
cup. I have found some sort of play the best way to get 
a child to take food. One child got amused over a great 
show of counting spoonfuls, and often forgot to resist 
swallowing the milk in his eagerness to count. A very 
spoilt child in my district probably owed his life to having 
a spoonful of milk put in his mouth each time he opened 
it to roar ! Sometimes some little reward can be promised. 
To get a child to take plenty of nourishment without 
crying or excitement often means to save its life. 

116. 16. In a bad illness a child that has been taught 
to be obedient and clean has far better chances of getting 
well than a disobedient and dirty child. The one takes its 
food and medicine quietly, allows all to be done for its 
good, and has not to be taken up or moved much. The 
other shrieks itself into a fever over being fed, resists 
treatment and medicine, so that sometimes a doctor has to 



48 HOME NURSING OF THE POOR. 

order both to be given up to spare the excitement and 
exertion, and has 'to be constantly moved, washed and 
have its linen changed, 

117. 17. Eickets is a complaint that comes almost 
always from bad feeding and bad air. The child is weak 
and cross. It gets thin, its stomach is too big, and often 
the head is too big also. The bones bend, so that often 
the child ends by being deformed. A child does not often 
die of rickets, but it is often ruined for life by it, and 
very often dies of complaints that it catches because rickets 
has made it so feeble. 

118. 18. To prevent rickets, feed the baby as you have 
heard it should be fed, and keep it out of doors as much as 
you can. When the child is older still give it plenty of 
milk : make rice puddings and cook oatmeal, fruit and 
vegetables for the children. Such feeding costs no more 
than tea, heavy dumplings and lumps of bread and butter 
and cheese. It is this sort of careless feeding and sleeping 
in rooms with the window shut (and the chimney shut up 
if there is a fireplace) that causes rickets. 

119. 19. " Bandy-legs " often come from letting a child 
stand before his legs are strong enough to bear the weight 
of his body. Sometimes a baby who is old enough to be 
on his feet a good deal is so fat that his legs bend under 
him, or has rickets, which makes the legs bend because 
the bones are soft. In either case, if you let the child 
stand and walk on legs that bend he will grow up " bandy- 
legged" (and it is very hard on a man or woman to be 
afflicted with an ugly deformity that a little care would 
have prevented). 

120. 20. Measles is not a serious complaint in itself, 
but if a chill sends the rash in, or keeps it from coming 
out properly, it may be very serious. Also a child with 



LECTUEB V. 49 

measles, or after measles, is liable to bronchitis, inflamma- 
tion of the lungs, a bad form of indigestion, a serious 
disease of the eyes, or inflammation of the ears. 

121, 21. To prevent a chill, keep a child with measles 
in bed as long as it is feverish. To prevent trouble with 
the eyes, do not let a strong light from window or lamp 
fall on them. To prevent indigestion (of a bad sort) give 
light food, such as bread and milk, milk-puddings or lightly 
boiled eggs. Don't be afraid to wash children with measles, 
but use hot water. A child wants care after measles be- 
cause it is weak, and liable to the complaints I have 
mentioned. If you notice any weakness of the eyes or 
running of the ears (or if the child has earache) you 
must take it to a doctor. Many cases of blindness or 
deafness are the results of neglect after measles. So 
don't let children strain weak eyes over lesson-books, or 
run about with aching or running ears stopped up with 
wool. Take them to the doctor at once. (There is a doctor 
appointed to see school children and say if they ought not 
to go to school.) 

122, 22. If a child complains of headache, feeling sick, 
sore throat and aching all over, and is feverish, it may 
be sickening for scarlet fever. Keep it warm and quiet, 
give it milk, and look out for a rash. It generally begins 
on the chest, or you may see it first inside the bends of 
the arms. Send for the doctor, and if you are living 
within reach of a fever hospital allow the child to go there 
without fear. With good nursing and care for some time 
afterwards scarlet fever is not often dangerous, and may 
leave no bad results. 

123, 23. If you are obliged to keep a case of scarlet 
fever at home, do your best not to let it spread. Nothing 
that has been in the room must go out of it without being 

4 



50 HOME NURSING OF THE POOR. 

disinfected. Eemeniber this rule. Ask the doctor about 
carrying it out in any way you are not sure of, and do 
exactly what he orders. 

The infection lasts till " peeling" has quite finished, 
and the soles of the feet always peel last. A child with an 
attack of scarlet fever that seems no worse than a bad 
cold may give it to another who will have it in the worst 
form. So be careful. 

124. 24. An experienced nurse is as careful over the 
getting better of a mild case of scarlet fever [scarlatina 
and scarlet fever are only different names for the same 
disease) as she is over a bad case. Peeling all over makes 
one very liable to chill, and a chill may cause kidney 
disease, rheumatism, abscess on the glands or in the ear 
after the child seems quite well. About three weeks after 
the fever begins take special care against a chill, then the 
kidneys are peeling and very sensitive. If the eyelids or 
limbs swell, if there is anything unusual about the 
breathing, or if it passes very little water, and that of an 
unusual colour, send word to the doctor, and put the child 
to bed ; keep it very warm, and give it nothing but milk. 
(All that has been said about scarlet fever applies equally 
to grown-up people.) 

125. 25. Sore throat or soreness and swelling on the 
glands may come from many causes, and are often not 
serious. As they may always be the beginning of ulcerated 
throat, quinsy, abscess on the gland, mumps, or some 
other complaint, always watch and take care till either 
are well. If a child who seems ailing and feverish sud- 
denly complains of sore throat, difficulty in swallowing, 
and the throat is tender outside, it is safer to have a 
doctor. These may be the first signs of diphtheria, and 
there is need of treatment at once. If it is possible, and 



LECTUBE V. 51 

the doctor advises it, let the child go to the hospital. With 
doctors on the spot, and the best skilled nursing, the child 
has a far better chance of getting well. If you must keep 
it at home, obey the doctor's orders in every detail exactly. 
Keep whatever spoons, cups, plates, or anything you use for 
the child in the room for him alone : afterwards ask how 
to disinfect them before they are taken out of the room. 
Do not let the child breathe or cough in your face. If 
he coughs or spits into your clothing or hands remove 
and cleanse the place with disinfectant at once. The child 
must be taken great care of for a long time after diphtheria. 
There is danger of paralysis of the heart for some time. 
(All this applies equally to grown-up people.) 

Questions on Lectuee V. 

101. 1. What is the only food an infant can digest? 
What sort of food can the juices in an infant's stomach 
and intestines change into nourishment ? 

102. 2. How much good does bread sop do a baby? 
Why? Say all you remember about bread sop for babies. 

103. 3. Should you give the baby a little of your own 
food? Why not? 

104. 4. What is the best sort of milk for a baby? 
Why are so many men, and such strong men, found in 
Japan ? 

105. 5. What sort of a feeding-bottle should you use? 
What would you do with it between the feeds ? Why 
does this sort of bottle save time in the end ? 

106. 6. Should a baby have " thrush " ? What causes 
the soreness of the mouth and the lower parts ? How 
should you prevent both ? 

107. 7. How would you prepare a bottle for a baby 
under a month old ? How between one month and seven 



52 HOME NURSING OF THE POOR. 

months ? How at seven months and after ? Say all you 
remember about this. 

108, 8. When should a child be weaned? When may 
it have thin broth ? When may it have meat ? 

109, 9. What are the four great rules for the right 
rearing of a baby ? 

1 10, 10. If a baby cries, and cannot be stopped, what 
must you make sure of ? If it has pain in the stomach 
what will you make sure of, and what will you do? 

111, 11. What are the three rules for a baby's clo- 
thing? What must you never use? 

112, 12. How would you know that a baby is danger- 
ously convulsed ? What would you do ? Say all you re- 
member. 

113, 13. Say all you would do if a child were attacked 
with croup. 

114, 14. How many sorts of croup are there? Why 
should you always act as if it were the worst sort when it 
comes on ? 

115, 15. Is it important that a sick child should take as 
much food as is ordered ? What is the best way to get a 
child to take food it does not wish to take ? What should 
you try to prevent when feeding a sick child ? 

116, 16. Say why a child that has been taught to be 
obedient and clean has far better chances of getting well 
than one that has been allowed to be disobedient and 
dirty? 

117, 17. What are the two chief causes of rickets? 
What are the signs of rickets? What harm comes of 
rickets ? 

118, 18. Say all you would do to prevent rickets. 
Mention two ways in which you may cause it. 

119, 19. What often causes " bandy-legs " ? Mention 



LECTUKE V. 53 

two cases in which a child old enough to run about is in 
danger of getting bandy-legged. What would you do ? 

120. 20. What may happen to a child with or after 
measles? Say all you remember. 

121 ■ 21. What care would you take of a child with or 
after measles ? Say all you remember. Would you wash 
it? 

122, 22. What signs should make you look out for 
scarlet fever? What would you do if you saw these 
signs? Where would you look for the rash? Why 
should you be willing to send it to a hospital? 

123, 23. If you nursed scarlet fever at home, what 
rule must you remember ? How long does the infection 
from scarlet fever last? What peels last? 

1 24, 24. Why must you take great care of a child get- 
ting better of a mild attack of scarlet fever ? Why is there 
danger of chill, and what may a chill cause ? Why must 
you take special care about three weeks after the fever be- 
gins ? What signs must you look for, and what will you 
do if you see any of these signs ? 

125, 25. What signs should make you on the watch for 
diphtheria ? If a case of diphtheria is nursed at home, what 
special care would you take against infection ? Say all 
you remember. Why must you take great care of a child 
for a long time after diphtheria ? 



LECTUEE VI. 

CONVALESCENCE— EMERGENCIES. 
Things Required foe Lectuee VI. 

1. Bed and patient, with extra blankets and pillows. 

2. Jacket or shawl. Slippers. 

3. Armchair. Footstool. Chair. Box. 

4. Diagrams (1) and (2). 

5. Handkerchief. Some old linen. Basin of water. 

6. A bed-rest. 



(54) 



LECTUEE VI. 

126« 1. When a person is getting better of an illness 
you must take care that he does not tire himself, get a chill, 
or bring on indigestion. Over-exertion or a chill is likely 
to throw him back into a feverish state. Indigestion will 
prevent his food from nourishing him, and perhaps bring 
on some fresh illness. 

127, 2. A person who gets a return of his illness or 
some new complaint after he begins to get better has 
very little strength left to fight against it. He will be a 
long time getting over it, and often he never does wholly 
get over it. Care when a sick person is getting better 
often means a perfect cure, instead of a chronic invalid. 

128, 3. The first thing allowed after a bad illness is 
sitting up in bed. A loose flannel jacket is best, but if 
you have not got one, cover the shoulders with something 
warm and light, and take care that the arms are kept in. 
The pillows at the back must be firm and high enough to 
rest the head. If you have not got a bed-rest, turn a 
chair upside down, with the outside of the back against 
the pillows, and the front legs against the back of the bed- 
stead or the wall. 1 To prevent slipping down, wrap any 
old wooden box in something clean (and aired) and put it 
against the foot of the bed so that the feet press against it. 

1 Do all this with bed-rest and with chair. 

(55) 



56 HOME NURSING OF THE POOE. 

As either a bed-rest or a chair generally brings a person 
down to the middle of the bed, you will not want a very 
big box. 

129, 4. The second stage in getting better is generally 
sitting up in a chair wrapped in blankets. Lay one 
blanket over the seat and arms of the chair, and over a 
footstool, leaving enough to turn up over the knees. Put 
pillows at the back and, if it is a hard chair, on the seat. 
If you have a warm dressing-gown or a jacket put it on 
the sick person before you uncover him. 1 Anyhow put 
something light and warm over his shoulders and arms. 
If you have no soft slippers, draw socks or stockings over 
his feet. Throw the other blanket round his shoulders 
and wrap him in it as he gets out (unless the dressing-gown 
is long and warm). Wrap one blanket well round the legs 
up to the waist, and the other must overlap it and cover 
up to the neck. The pillows must rest the head. 

130. 5. In winter see that the room is warm, and have 
a hot bottle instead of a footstool. In hot weather be 
careful of draughts and wrap up the legs as I have told 
you, but don't keep too much on the shoulders, or the sick 
person will probably turn faint. Ask the doctor how long 
he may sit up, and never keep him up longer. But if he 
turns faint or feels too tired let him go back to bed. 
Often a sick person can stay up longer if he sees the bed 
all ready for him to get into it. If it is unmade he is 
afraid of having to wait while it is made. Remember that 
any one is very low and nervous after a long or severe 
illness, and ought to be humoured in every little thing 
that does him no harm. I once found a woman sitting 
with her head down on her knees, almost fainting. The 

1 Do all this with dressing-gown and without. 



LECTURE VI. 57 

bed was unmade, and two women sat looking on. This 
was because the doctor said she was to sit up for an hour ! 
She never got well. The doctor always means you to 
use your common sense in obeying this order. 

131. 6. If you are short of pillows, use the cushions 
and bolsters of sofas and chairs downstairs, or even 
shawls or anything else rolled up. Ahvays put them in 
pillow cases if you can. If you have not an armchair 
put the lowest and largest chair you have in a corner 1 
against a chest of drawers, or something solid, and arrange 
your pillows accordingly. If you have not a footstool use 
a box, a child's chair, or anything low. Think, and use 
your common sense. 

132. 7. The first time a sick person dresses have the 
clothes all ready at hand : clean, aired, and (in winter) 
warmed. The first time he goes out see that he is warm 
and has just taken something nourishing before he starts, 
and bring him in before he gets tired. 

133. 8. If a person who is getting better has no 
appetite, take thought and trouble to tempt him. Don't let 
him know what he is going to have. Cook it nicely, and 
put it on the plate nicely, and a little at a time. Be very 
punctual. If he has a great appetite you must be 
careful not to let him have too much. The great secret 
of getting really well is to be slow and sure. A little 
more done and a little more food taken every day. The 
rule of feeding a " convalescent " person is much the same 
as for feeding a sick person. Give all the doctor allows. 
Give nothing that he does not allow. 

1 34. 9. As these lectures are nursing and not ambulance 
lectures, I can only give you a few directions about what 

1 Show how to arrange chair in corner if you can conveniently. 



58 HOME NURSING OF THE POOR. 

to do in " emergencies ". As the most common and 
terrible emergency is a fire, we will take that first. 

Bemember that flames always go up. So if your clothing 
catches fire, throw yourself doion on the floor at once. 
Crawl or roll to any rug, tablecloth, curtain, or anything 
you can roll yourself in. In that way you are almost 
certain to put the fire out before it has done you much 
harm, or got to your face or hair. Don't rush to the 
door and stand in a draught shrieking. The draught and 
your upright position will cause the flames to shoot up, 
and you will be sure to be scarred on the face and lose 
your hair, if you don't lose your life. 

135. 10. If you are with any one whose clothing catches 
fire force her to lie down at once, and roll her up in the first 
thing you can get hold of. If anything catches fire pull it 
down if it is hanging up : smother it : shut doors and windows. 

136. 11. In removing the clothing of a burnt or 
scalded person, take great care not to break the skin. 
It is better to cut a sleeve or a stocking or a vest than 
to drag so as to break the skin, and so change a slight 
injury into a serious one. If a child steps into boiling 
water (which they often do, and never ought to have a 
chance of doing), you may wrap cloths saturated in oil 
(carron, olive or linseed) very gently round, outside the 
sock, till the pain and inflammation are gone down. Then 
you had better cut it down. (Unless you know for certain 
that nothing has been done to drag the skin off you had 
better get the sock off at first. ) 

137. 12. Burns are of three classes : (1) when the skin 
is inflamed but not blistered; (2) when the skin is 
blistered but not broken ; (3) when the skin is broken 
and the flesh burned and charred. 

138. 13. In any burn or scald the first object is to 



LECTURE VI. 59 

exclude the air. If you are wise enough to keep carron 
oil in the house, use that. Olive or linseed oil or vaseline, 
or boracic ointment are all very good. If the skin is not 
blistered or broken you may use flour or wadding. Get 
some one to dip rags in oil or spread vaseline or ointment 
on them while you remove the clothing, and as you un- 
cover each bit of the burn or scald cover it with dressing. 
If you use flour, powder it on thickly so as to keep the air 
off, and cover with wool ; then soft old flannel, or soft rag. 

139. 14. Except for the most trifling burns or scalds 
have a doctor, because there are several dangers in 
such cases, even when the injury seems small. (I have 
known a child to die of blood-poisoning from a scald, 
caused by the spilling of a cup of tea.) If the burn or 
scald is at all serious let some one run for the doctor at 
once ; but do not lose a moment in getting dressing over 
the burnt or scalded part. 

140. 15. One danger from a large burn or scald is 
what is called " shock ". If the person turns pale, seems 
to take little notice, breaks out in cold perspiration, or shows 
any such signs of sinking, you must act quickly. Put hot 
bottles (ginger-beer bottles will do if you cannot get bigger 
ones) to the feet and stomach, keep the head low. Give 
stimulant with a teaspoon slowly. Give hot tea or coffee 
if it does not cause a feeling of sickness. 

141. 16. If any one is bleeding a great deal you must 
do all you can to stop it before the doctor comes. (Of 
course you must send for him at once.) If the blood 
oozes out it is from a little blood-vessel. If it is bright 
red and jets out it is from an artery. If it is very dark 
and streams out it is from a vein. 1 

1 Show diagram 1. 



60 HOME NURSING OF THE POOR. 

142, 17. In any case of bleeding, raise :':c ::»:b "::":. 
.:■•:,: :.: : v : 'rids and e ver;.;:hin:i ;<::■. :■:>,"■ a>--: 

r.'.'j clean. Bleeding from an artery must be stopped 
by pressure above the wound ; because in arteries blood 
is :oming r; ;»; the heart. Bleeding from a vein must be 
stopped by pressure below the wound, because blood in 
the T :~eins is going to the heart. 1 

143, 13. You may be able to stop the bleeding when 
the limb is well raised by pressing with your thumbs 
above or below the wound. If not, tie a handkerchief 
round tightly, above or below, according to whether the 
blood comes from a vein or an artery. 2 If it stops bleed- 
ing, on no account leave it tied up and think it is all right. 
Yon must get a doctor, or get the person taken on an 
ambulance to the hospital at once. 

144, 19. Oozing can generally be stopped by raising the 
limb and dropping clean cold water on the place/ 5 2s ever 
\sc ccoit-sbs to stc-v bleeding. Never give -stiyn:d.ants : they 
make the blood go faster. 

145, '20. If a person is subject to epileptic fits, you 
can do a good deal to prevent them. See that the bowels 
act regularly, that he eats nothing indigestible, and takes 
very light suppers. During the fit all you can do is to 
loosen the clothing about his neck, put something between 
his teeth to prevent him from biting his tongue (a folded 
kauakerckief. or the handle of a teaspoon, or something 
that will no: slip down his throat), and stay with him till 
it is over. Never try to make him take anything during 
the fit. When it is over let him have his sleep out without 
being disturbed.. You ought to take the greatest pains to 
prevent epileptic tits because, though they seldom cause 

i Show diagram 2. - Show all this. 3 Do this. 



LECTURE VI. 61 

death directly, if they are frequent and severe they ruin 
health of mind and body. 

146. 21. Hysterical fits often look like epilepsy, but the 
person is not really unconscious, and never hurts herself. 
She will resist if you try to open her eyelid, and the eye 
sees and feels. The less notice you take of hysterical fits 
the better. They are sometimes cured very quickly by a 
suggestion of cutting the hair, dousing with cold water, 
or any other unpleasant treatment. Hysteria must not 
be looked on as a deliberate sham, it often comes from 
weak health. But it makes a girl or a woman so ridiculous 
and such a nuisance to every one that you ought to be 
very firm with any one who gives way to it. The best 
rule is, take as little notice as possible of any one who is 
hysterical. Desire for notice causes the silly actions and 
selfish ways of hysterical people. 

147. 22. When any one has an apoplectic fit send for 
the doctor at once. Move the person as little and as gently 
as possible, lay him with his head and shoulders raised, 
loosen his clothing about the neck, put a hot bottle to his 
feet (as he probably cannot feel take care not to blister or 
burn him), put cold wet rags on his head, and keep him 
quiet and still. Remember that the seat of the complaint 
is in the head, so move it gently when you must, keep it 
settled comfortably and raised ; ask the doctor if you are 
to go on putting wet rags on it. If so have two pieces of 
rag, wring them well, and change them often. 

148. 23. Death or paralysis for life often result from 
apoplexy, and the whole or partial cure often depends on 
careful nursing. Do all that the doctor orders thoroughly, 
and if you fail tell him how and why. For instance, if he 
orders an enema, and the soap and water runs back as you 
try to inject it, or comes back directly without causing any 



62 HOME NURSING OF THE POOR. 

action of the bowels, then or later, the doctor must know, so 
that he may order something else. Often the throat is partly- 
paralysed, and sometimes you can only give a few drops 
of milk at a time, watching for the gulp of swallowing 
between each. Be most careful not to cause choking. As 
a person with apoplexy is helpless, and the bed is likely to 
be wet and soiled often, take all the care you know to pre- 
vent bedsores. As he breathes with his mouth open, take 
care it does not get sore through dryness. Make the bed 
and change the linen as for a typhoid case, with special 
regard to the head. There is no case in which a sick 
person is so dependent on his nurse, or in which she can 
do more for his good and comfort, than a person in an 
apoplectic fit, or helpless with paralysis afterwards. 

149. 24. Be careful to distinguish one sort of fit from 
another. A person with epilepsy is convulsed, all or part 
of the body jerks and twitches, his eyes do not see or feel, 
and he will not resist your opening the lids. An hysterical 
fit may have all these symptoms, except that the person will 
resist your opening the eyelids, and probably betray in some 
other way his consciousness. A person with apoplexy is 
seldom convulsed, and generally the face is flushed. He 
loses consciousness suddenly, breathes loudly, the pupils of 
the eyes are fixed, and one or both is "dilated," that is, 
big. He will also be paralysed on one side. Do not 
mistake apoplexy for drunkenness even if the breath smells of 
drink. Total unconsciousness, noisy breathing, or one 
pupil bigger than the other distinguish apoplexy from the 
stupor caused by drink. 

1 50, 25. In any case of suffocation from drowning, hang- 
ing, gas, or any other cause, breathing often stops some 
time before a person is dead ; and by making the person 
breathe " artificially," real breathing is sometimes started 



LECTUBE VI. 63 

again, even two hours after what looks like death. So 
always try it at once, while you wait for the doctor. 

Lay the person on his back, with his shoulders and 
head slightly raised. 1 If the case is strangulation turn 
him face downwards for a moment, and clear out with the 
fingers any accumulation of thick stuff at the base of the 
tongue (that is, by the throat). In a case of drowning 
you must do this also, and lay the head on one side, so 
that any fluid must ooze out of the mouth. In all cases 
loosen all the clothing, draw the tongue out of the mouth, 
and let some one hold it in his finger and thumb with a 
handkerchief or it will slip (or you may fasten it with 
any sort of elastic band under the chin, if you have one 
with you). 2 

Stand, or, if the person is on the ground, kneel behind him. 
Grasp his arms above the wrists, pull them away from 
the sides, and up till they meet above the head ; keep them 
there for about two seconds. Then bring them slowly z 
back again till the elbows meet over the chest. Press 
with your hands over the arms on the chest, then begin 
again. Repeat these two movements slowly, not more 
than sixteen times in a minute. Keep on (if no result) for 
two hours, or till a doctor tells you it is of no use. 

If you happen to be on the spot where some one hangs 
himself, remember that your first duty is to cut the body 
down ; and drag a table under it, or get up on something, 
or take any care you can not to let it fall. Many lives 
are lost through a mistaken idea that a hanging person must 
be left untouched. Besides not saving a life, you are liable 
to be blamed at an inquest for such neglect. 

1 Lay the patient on the floor. Roll something up to put under 
his head. 

2 Show how to do all this. 3 Do this. 



64 HOME NURSING OF THE POOR. 

Now I hope you will all try to practise what you have 
learnt here, as you have opportunity ; not only in your 
own house, but to teach and help people about you. (I 
know one excellent nurse, a poor woman, who has con- 
stantly practised what she has learnt at lectures, and 
from helping trained nurses. She could make a good 
living by her nursing, and is a blessing to the neighbours 
all round her.) 

Questions on Lecture VI. 

126. 1. What special care must you take of a person 
who is getting better of a serious illness ? Mention three 
points, and give the reason for each ? 

127. 2. Why is it so important not to let a person who 
is getting better get ill again? Say all you remember, 
and the difference great care at that time will probably 
make. 

128. 3. Say all you would do when a sick person is 
first allowed to sit up in bed. 

129. 4. Say all you would do in getting a person up for 
the first time, not dressed. (Say only up to the time you 
settle him in his chair, and at any time of the year.) 

130. 5. What special care would you take in winter 
when getting a person up for the first time? And in 
summer ? Should you keep him up as long as the doctor 
orders ? 

131. 6. What should you do if you had not enough 
pillows, or an armchair, or a footstool ? 

132. 7. Say all the care you would take when a sick 
person is (1) dressed for the first time ; (2) goes out for the 
first time. 

133. 8. Say all you would do to tempt a sick person, 
getting better, who has no appetite. What care would 



LECTUEE VI. 65 

you take with a person who is very hungry ? Give the one 
great rule in feeding a person who is getting better of an 
illness. 

134. 9. What is the main thing to remember when 
any one's clothing or anything catches fire? Say all 
you would do if your clothing caught fire. Say one thing 
you must never do. 

135. 10. What would you do if some one else's clothing 
caught fire, or if anything caught fire ? 

136. 11. What great care must you take in removing 
clothing from a burnt or scalded person ? How may you 
change a slight injury into a serious one ? What must you 
do rather than drag anything off? What may you do 
when a child has walked into a pan of boiling water? 
When is the only time that you may do this ? 

137. 12. Mention the three classes of burns. 

138. 13. What is the thing to do in any burn or scald? 
What may you use ? When only may you use flour or 
wool ? Say how you would set about getting dressing on 
a burn or scald. 

139. 14. When must you have a doctor for a burn or 
scald ? Why ? Would you run for the doctor yourself ? 

140. 15. What are the signs of' 'shock"? What would 
you do if you saw those signs in a person who had been 
burnt or, scalded ? 

141. 16. If any one bleeds a great deal, how will you 
know whether it comes from an artery, a vein, or a 
small blood-vessel ? 

142. 17. What must you do in any case of bleeding, 
and what care must you always take? Where must 
pressure be used to stop bleeding from an artery ? Why ? 
Where to stop it from a vein ? Why ? 

143. 18. How would you apply pressure to a blood- 

5 



66 HOME NURSING OF THE POOR. 

vessel ? If you manage to stop the bleeding, should you 
leave the handkerchief on and think it is all right ? What 
must you do ? 

144, 19. What will generally stop oozing? Should 
you use cobwebs to stop bleeding ? 

145, 20. What can you do to prevent epileptic fits? 
, What must you do during the fit, and after ? Why should 

you take the greatest pains to prevent epileptic fits ? 

146, 21. How would you treat an hysterical fit? Why 
should you be very firm with any one who gives way to 
hysteria ? 

147, 22. Say all you would do for a person in an 
apoplectic fit up to the time that the doctor comes. 

148, 23. Mention two results to be feared from an 
apoplectic fit. What special care would you take in 
feeding a person whose throat was partly paralysed ? Say 
all you can remember of the special care you would take 
in nursing a person in or after an apoplectic fit. 

149, 24. How would you know epilepsy, hysteria 
apoplexy ? How would you know apoplexy from drunken- 
ness? 

150, 25. In any case of suffocation, such as drowning, 
hanging, or from gas, what must you try to do ? What 
special care must you take before you begin in a case of 
(1) strangulation ; (2) drowning ? Say all you can re- 
member of what you would do. What must you do if 
you are on the spot when a person is found hanging? 
Say all you can remember. 



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